Acid Reflux (Gastroesophageal Reflux Disease GERD)

Acid Reflux or Gastroesophageal Reflux Disease (GERD) is a condition in which liquid stomach contents are regularly sent into the esophagus (oesophagus).

This happens due to temporary or permanent changes in the barrier between the esophagus and the stomach.

It can be due to weakness of the lower esophageal sphincter (LES). Chemicals such as caffeine, alcohol, chocolate and nicotine can cause the weakness of the LES.

Other causes can be transient LES relaxation, slower emptying of the stomach or association with a hiatal hernia.

In some patients, the liquid can agitate and damage the lining of the oesophagus. This is because, whereas the lining of the stomach has cells that can tolerate digestive juices, the oesophagus is unable to tolerate these acids. Once GERD begins, it is usually life-long.

Occasional heartburn is common. It does not necessarily mean one has GERD. In patients with GERD, the refluxed liquid contains acid more often. The acid also remains in the esophagus longer.

If you have heartburn symptoms, more than once a week, then you may be at risk of developing GERD.

Reflux of acid is more damaging at night than during the day. At night, individuals are lying down. It is therefore easier for reflux to occur because gravity is not opposing it, as it does in the upright position during the day.

Lack of gravity allows the refluxed liquid to travel further up the esophagus and remain there longer.

Acid Reflux Symptoms in Adults

The major symptom of GERD is heartburn. Heartburn is the sensation of burning pain in the chest coming upward towards the mouth.

It is caused by reflux of acidic contents from the stomach to the esophagus. Acid reflux is more common after meals; heartburn is therefore more common after meals.

Another widespread symptom of acid reflux is the feeling of a sour or salty taste at the back of the throats. This is due to regurgitation. At times, this can happen even if the pain of heartburn is absent.

Other acid reflux symptoms are:

  • Nausea
  • Vomiting
  • Chest pain
  • Difficulty swallowing
  • Bad breath
  • Bitter taste in the mouth
  • Repeated throat clearing

    Presence of a hiatal hernia is not a symptom of acid reflux. However, a hiatal hernia existence is a risk factor for development of GERD.

    Likely GERD Complications

    The following acid reflux complications are likely to occur:

  • Ulcers in the esophagus that may result in severe bleeding
  • Strictures or scarring of esophagus (especially young children).
  • Barrett's esophagus also called Barrett's Disease
  • Cough and asthma
  • Esophageal cancer
  • Inflammation of the throat and larynx
  • Inflammation and infection of the lungs

    Trouble swallowing requires immediate medical attention. Vomiting blood or partially digested blood also requires immediate medical attention.

    GERD in Children

    Acid reflux can be easily overlooked in infants and children. The symptoms of GERD in children may vary from adult symptoms. Children may have one symptom or many. No single symptom is present in all children with acid reflux.

    GERD in children may cause:

  • Repeated vomiting
  • Effortless spitting up
  • Coughing
  • Other respiratory problems.
  • Inconsolable crying,
  • Failure to gain adequate weight,
  • Refusing food
  • Bad breath

    An immature digestive system is generally the cause of GERD in infants. Most infants stop having acid reflux by the time they reach 12 months.

    A number of children do not outgrow acid reflux. They can continue to have it into their teen years.

    If a child has heartburn that does not go away for a while, or other symptoms of GERD, medical help should be sought.

    Acid Reflux Diagnosis

    Persistence of heartburn and its response to treatment would normally give suspicion of the presence of GERD. The diagnosis in this case is not conclusive since other conditions can mimic GERD.

    Patients need to be treated with medications to suppress the production of acid by the stomach if GERD is to be confirmed.

    Diagnosis may also be done through barium swallow X-rays, esophageal manometry, esophageal pH monitoring and Esophagogastroduodenoscopy (EGD).

    An EGD is done when the patient does not respond well to treatment. It is also done when the patient has had symptoms or required medications for a long period of about 5 years. It can also be done if the patient has weight loss or changes in the voice.

    Esophagogastroduodenoscopy (EGD) is a form of endoscopy. During Esophagogastroduodenoscopy, the patient is first sedated. A thin scope (camera) is then inserted through the mouth and throat into the esophagus and stomach. The doctor is then able to assess the internal surface of the esophagus, stomach and duodenum.

    Likely Causes of GERD

    GERD indicates weakness of the lower esophageal sphincter. Increased acidity or excess production of gastric acid can contribute to the problem.

    On the other hand, GERD-like symptoms can be caused by absence of enough stomach acid or hypochlorhydria.

    The valve that empties the stomach into the intestines is activated by acidity.

    If there is not enough acid, the valve does not open and the stomach contents are stirred up into the esophagus.

    Other factors that can contribute to acid reflux include:

  • Obesity
  • Tight fitting clothes
  • Pregnancy (due to elevated hormone levels & increased pressure in the abdomen)
  • Yeast infections of the digestive tract
  • Hiatus hernia
  • Zollinger-Ellison syndrome
  • Hypocalcaemia (Increased gastrin production leading to increased acidity)
  • Scleroderma
  • Systemic sclerosis

  • Acid Reflux Diet & Treatment

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